Randomized control trial of integrated community health worker services and primary care practices for Low-Income people with asthma

Introduction: Public Health-Seattle & King County, in partnership with local community health centers, health plans, and other health experts, implemented a two-year clinical trial to assess the comparative effectiveness of a community health worker (CHW) home visit intervention compared to no CHW intervention. This trial was nested in a feasibility study of a planned preventive asthma clinic intervention compared to usual care. We focus on the impacts and challenges of integrating CHWs and enhanced asthma clinical care on patient asthma control. Methods: The CHW intervention included three protocol-driven home visits. The enhanced asthma clinic intervention included quality improvement tools, training, and support. Our study population of 551 participants, ages 5-75 years, included African American, Hispanic/Latino, and other low-income asthma patients, and three language groups: English, Spanish, and Somali. Primary outcome measures included self-reported asthma symptom-free days, Asthma Control Test score, and asthma-related quality of life. Secondary outcome measures included nights awakened due to asthma, asthma-related urgent care utilization with hospitalization, β-agonist use, oral steroid use, and school/work days missed. Data were collected 2015-2017 using pre/post patient surveys, home environmental checklist, and mid-point interviews with CHWs, clinic staff, and health plans. Results: Findings showed significant improvement in asthma-related quality of life and nocturnal wakening in the CHW arm. Feedback from clinic staff, leadership and health plans was uniformly supportive about integrating CHWs into asthma care practice and spreading aspects of the enhanced clinic intervention. Conclusions: Findings from this study highlight the value of CHWs for improving asthma outcomes. More importantly, the protocols used in this study demonstrate how CHWs can feasibly be integrated into existing processes of care, in alignment with the Chronic Care Model. While the future of reimbursements for CHWs is uncertain, there is opportunity and momentum to capitalize on the integration of CHWs into asthma clinical care.